Rumination and Excessive Reassurance-Seeking in Depression: A Cognitive–Interpersonal Integration

Respiratory sinus arrhythmia moderates the interpersonal consequences of brooding rumination

Brooding rumination is an intrapersonal emotion regulation strategy associated with negative interpersonal consequences. Resting respiratory sinus arrhythmia (RSA), a psychophysiological marker of self-regulatory capacity, may buffer the association between maladaptive emotion regulation and negative interpersonal behaviors. The current work examines the moderating effect of RSA on the association between brooding rumination and different negative interpersonal consequences. Across three convenience samples, individuals with lower RSA showed a stronger association between brooding rumination and more negative interpersonal behaviors as well as less perception of received instrumental social support (Study 1; n = 154), higher levels of interviewer-rated interpersonal stress (Study 2; n = 42) and a stronger indirect association between brooding rumination and depressive symptoms via daily interpersonal stress (Study 3; n = 222). These findings highlight the negative interpersonal consequences of brooding rumination, particularly among individuals with lower RSA.

NEGATIVE FEEDBACK SEEKING AND EXCESSIVE REASSURANCE SEEKING BEHAVIOR AND DEPRESSION: A META-ANALYTIC REVIEW

Introduction: Negative feedback seeking and excessive reassurance seeking behaviors in interpersonal relationships have been shown to frequently occur in conjunction with levels of depression.

Method: We used meta-analysis to examine 102 studies (134 effects), relating depression with negative feedback seeking (k = 31) and/or excessive reassurance seeking (k = 103).

Results: Depression had positive, moderate effect sizes with both negative feedback seeking (r = .26, 95% CI [.21, .32], p < .001, k = 31) and excessive reassurance seeking (r = .33, 95% CI [.31, .36] p < .001, k = 103). Subgroup analysis revealed the effect size for negative feedback seeking was smaller in romantic relationships compared to other relationship types. Effect sizes for excessive reassurance seeking did not differ for romantic and other relationships but were smaller in romantic relationships of a longer duration. Participant gender and symptom severity did not moderate effect sizes. Studies with child and adolescent samples had larger effects for negative feedback seeking and smaller effects for excessive reassurance seeking, relative to adult samples.

Discussion: Longer closer relationships may protect against maladaptive interpersonal behaviors in individuals with depression.

The moderating role of rumination and social sharing in the relationship between mistreatment and service sabotage and depersonalization: A cross-sectional study of hospital nurses

BACKGROUND

Research has consistently shown that service sabotage is most often an act of retaliation motivated by customer mistreatment. To date, however, service sabotage has seldom been studied among nurses.

OBJECTIVES

To examine the impact of mistreatment by patients and relatives on service sabotage and depersonalization among nurses and explore the moderating role of two emotion-regulation strategies, rumination and social sharing, in the relationships between mistreatment and both outcomes.

DESIGN AND METHODS

A cross-sectional design was used to collect data from nurses working in a mid-size general hospital in Northern Israel. The sample consisted of 217 nurses. Data were collected using self-reported anonymous questionnaires and analyzed using hierarchical multiple regression.

RESULTS

More than a quarter of the nurses surveyed reported frequent exposure to mistreatment by patients or relatives, and 26.4% reported engaging in sabotage acts occasionally or often. Findings demonstrated that both social sharing and rumination were strategies that were frequently employed following mistreatment. Mistreatment and rumination significantly predicted both service sabotage and depersonalization. The results further revealed that rumination exacerbated the effect of mistreatment on service sabotage and that social sharing increased the impact of mistreatment on depersonalization. Rumination also moderated the relationship between social sharing and service sabotage, such that social sharing was positively associated with service sabotage only among nurses who tended to ruminate more frequently.

CONCLUSIONS

This study contributes to the existing literature by pointing out that when encountering aggressive patients, nurses may engage in revenge seeking behavior in the form of service sabotage, and that not only rumination but also social sharing may intensify the negative effects of mistreatment. Social sharing can become an especially maladaptive coping strategy for individuals who tend to engage in high levels of rumination. The present findings underscore the necessity to further explore the moderating role of emotion regulation strategies in the relationship between mistreatment and work outcomes, and to clarify the conditions under which nurses might tend to engage in acts of sabotage directed at patients.

Mind the Gap: The Relation Between Identity Gaps and Depression Symptoms in Cultural Adaptation

Personal-enacted identity gaps, defined as the difference between an individual’s self-view and the self that one expresses in communication, affect depression levels of international students living in the United States. Thus, identity gaps are an important construct for understanding the relation between identity and health outcomes. The present research examined the relation between personal-enacted identity gaps formed through communication with Americans and depression, extending previous work by considering the roles of acculturative stress and self-construal and providing one of the first tests of the relation between identity gaps and acculturative stress. A sample of 171 undergraduate and graduate international students studying in the United States was recruited to participate in an online study consisting of self-report questionnaires. Results indicated that as hypothesized, higher levels of personal-enacted identity gaps were associated with depression symptoms and that acculturative stress mediates this relation. However, independent self-construal did not moderate the relation between these variables. Testing additional models revealed multiple ways in which these factors could affect each other. Overall, results suggest that personal-enacted identity gaps, acculturative stress, and depression symptoms are important to consider in tandem in order to understand the emotional experiences of the international students and identify who is at risk for poor mental health. Future longitudinal research is needed to further understand the relations amongst these factors.

Perseverative negative thinking predicts depression in people with acute coronary syndrome

OBJECTIVE

Depression is common in people who have experienced recent Acute Coronary Syndrome (ACS), and predicts worse medical outcomes. Mechanisms underpinning the development of depression and its association with poor medical outcomes are unclear however. The aim of this study was to investigate the role of perseverative negative thinking (e.g. worry and rumination) in predicting depression in people with recent ACS.

METHODS

Adults attending specialist inpatient and outpatient cardiology services who had recently experienced ACS were invited to participate in this observational prospective cohort study. Questionnaire assessments were completed within 6months of index ACS (baseline), then 2months and 6months later.

RESULTS

169 participants (131 male (78%), median age 68 (±16) years) completed baseline questionnaires, and 111 completed follow-ups. After controlling for the effects of key covariates, baseline rumination was a significant predictor of depression at 6months, accounting for 2% of the variance in depression. This association was partially mediated by poor problem-solving ability and lack of social support. Neither worry nor rumination at baseline were significant predictors of quality of life at 6months.

CONCLUSIONS

Rumination is a significant independent predictor of depression, and this association may be partially explained by deficits in problem-solving ability and reduced social support. Both rumination and problem solving may provide useful targets for the development of evidence-based interventions to reduce depression among people with coronary heart disease.

Determinants of Excessive Reassurance-Seeking: Adolescents' Internalized Distress, Friendship Conflict, and Inhibitory Control as Prospective Predictors

Substantial research suggests that excessive reassurance-seeking behavior is associated with exacerbations in depressive symptoms and later interpersonal rejection, yet remarkably few studies have examined predictors of this maladaptive social behavior. This study proposed and examined a diathesis stress model suggesting that beyond the effects of prior internalized distress, a combination of poor inhibitory control and dyadic friendship conflict may be especially relevant predictors of adolescents' excessive reassurance-seeking behavior. Longitudinal associations were examined in a sample of 865 adolescents (54.5% female, 22.2% African American, 23.1% Latinx) who completed self-reported measures of depressive rumination/intrusive thoughts, depressive symptoms, loneliness, friendship conflict, and a performance-based measure of inhibitory control at baseline, as well as a measure of excessive reassurance-seeking at baseline and 2 years later. Results initially revealed a prospective effect of depressive rumination/intrusive thoughts on later excessive reassurance-seeking, consistent with prior work. Final results yielded only a significant interaction effect, revealing that higher levels of friendship conflict coupled with low levels of inhibitory control were associated longitudinally with higher levels of excessive reassurance-seeking. Findings suggest that inhibitory control may moderate the association between adolescents' interpersonal conflict and their excessive reassurance-seeking.

Self-Report Versus Informant Responses: Exploring the Relationship between Excessive Reassurance Seeking and Depression

Introduction: This study expanded on prior research exploring the relationship between excessive reassurance seeking (ERS) and depression by conducting a longitudinal study evaluating two reporting sources (participants and informants). The current research was also the first to examine a sequential mediation model, with interpersonal competence as an antecedent in this relationship.

Method: One hundred and ten participants completed measures at two time-points separated by five weeks. Corresponding informants completed comparable measures at participants' Time 2.

Results: Results revealed differences based on reporting source, with more significant correlations found among participant- as compared to informant-reported variables. Moreover, findings supported interpersonal competence as an antecedent to the ERS-depression relationship. Finally, this research highlighted the role of brooding, in addition to ERS, in the development of depressive symptoms.

Discussion: This study offers support for further consideration of methodology on outcomes, underlines the role of interpersonal competence as a precursor to depression, and encourages clinicians to target both brooding and ERS behavior in the treatment and prevention of depression.

Temperament clusters associate with anxiety disorder comorbidity in depression

BACKGROUND

Individual temperament is associated with psychiatric morbidity and could explain differences in psychiatric comorbidities. We investigated the association of temperament profile clusters with anxiety disorder comorbidity in patients with depression.

METHODS

We assessed the temperament of 204 specialized care-treated depressed patients with the Temperament and Character Inventory (TCI-R) and their diagnoses with the Mini International Neuropsychiatric Interview. Two-step cluster analysis was used for defining patients' temperament profiles and logistic regression analysis was used for predicting different anxiety disorders for various temperament profiles.

RESULTS

Four temperament clusters were found: 1) Novelty seekers with highest Novelty Seeking scores (n = 56),2) Persistent with highest Persistence scores (n = 36), 3) Reserved with lowest Novelty Seeking scores (n = 66) and 4) Wearied with highest Harm avoidance, lowest Reward Dependence and lowest Persistence scores (n = 58). After adjusting for clinical variables, panic disorder and/or agoraphobia were predicted by Novelty seekers' temperament profile with odds ratio [OR] = 3.5 (95% confidence interval [CI] = 1.8 - 6.9, p < 0.001), social anxiety disorder was predicted by Wearied temperament profile with OR = 3.4 (95% CI = 1.6 - 7.5, p = 0.002), and generalized anxiety disorder was predicted by Reserved temperament profile with OR = 2.6 (95% CI = 1.2 - 5.3, p = 0.01).

LIMITATIONS

The patients' temperament profiles were assessed while displaying depressive symptoms, which may have affected results.

CONCLUSIONS

Temperament clusters with unique dimensional profiles were specifically associated with different anxiety disorders in this study. These results suggest that TCI-R could offer a valuable dimensional method for predicting the risk of anxiety disorders in diverse depressed patients.

Rumination, Excessive Reassurance Seeking, and Stress Generation Among Early Adolescent Girls

Nolen-Hoeksema proposed that rumination increases stressful events and circumstances; however, few studies have examined this question. Thus, we explored whether (a) rumination predicted increases in the generation of chronic and acute stress, (b) excessive reassurance seeking (ERS) mediated links between rumination and stress generation, (c) rumination increased exposure to acute independent (uncontrollable) stress, and (d) rumination predicted chronic stress generation in certain domains, but not others. These questions were examined in a 1-year study of 126 early adolescent girls ( M age = 12.39 years) using contextual objective stress interviews. Findings indicated that rumination predicted increases in acute dependent interpersonal stress and chronic interpersonal stress, and ERS mediated these associations. Moreover, rumination was not associated with acute independent stress. Finally, the effect of rumination on chronic stress generation was most salient in adolescents' romantic lives and in parent-adolescent relationships. These findings suggest that ruminators create stressful interpersonal environments.

Nonlinear Associations Between Co-Rumination and Both Social Support and Depression Symptoms

Co-ruminating about one's problems appears to involve both beneficial self-disclosure and harmful rumination, suggesting that moderate levels may be the most adaptive. This study used nonlinear regression to determine whether moderate levels of self-reported co-rumination in relationships with a sibling, parent, friend, and romantic partner are linked to the highest levels of self-perceived social support and lowest levels of self-reported depression symptoms in 175 emerging adults (77% female; M = 19.66 years). As expected, moderate co-rumination was associated with high social support across all four relationship types, but, somewhat unexpectedly, high levels of co-rumination were also associated with high social support. As predicted, moderate levels of co-rumination with friends and siblings were associated with low levels of depression. Contrary to hypotheses, high levels of co-rumination were associated with high depression within romantic relationships. Co-rumination with a parent did not have a linear or quadratic association with depression. These findings suggest that high co-ruminating in supportive relationships and to a lesser extent low co-ruminating in unsupportive relationships are maladaptive interpersonal processes but that co-rumination's relation to depression depends on the co-ruminating partner. Psychotherapies for depression may target these maladaptive processes by supporting clients' development of balanced self-focused negative talk.

Social support seeking and early adolescent depression and anxiety symptoms: The moderating role of rumination

This study examined how social support seeking and rumination interacted to predict depression and anxiety symptoms six months later in early adolescents (N = 118; 11 - 14 yrs at baseline). We expected social support seeking would be more helpful for adolescents engaging in low rather than high levels of rumination. Adolescents self-reported on all measures at baseline, and on depression and anxiety symptoms six months later. Social support seeking predicted fewer symptoms of depression and anxiety at low rumination levels, but lost its adaptive effects as rumination increased. For depression symptoms, social support seeking led to more symptoms at high rumination levels. Results were stronger for emotion-focused than problem-focused support seeking, and for depression compared to anxiety symptoms. These findings suggest that cognitive risk factors like rumination may explain some inconsistencies in previous social support literature, and highlight the importance of a nuanced approach to studying social support seeking.

Gender differences in rumination: A meta-analysis

Starting in adolescence and continuing through adulthood, women are twice as likely as men to experience depression. According to the response styles theory (RST), gender differences in depression result, in part, from women's tendency to ruminate more than men. A meta-analysis was performed to evaluate gender differences in rumination in adults (k = 59; N = 14,321); additionally, an analysis of subtypes of rumination - brooding and reflection - was conducted (k = 23). Fixed effects analyses indicated that women scored higher than men in rumination (d = .24, p < .01, SEd = .02), brooding (d = .19, p < .01, SEd = .03) and reflection (d = .17, p < .01, SEd = .03); there was no evidence of heterogeneity or publication bias across studies for these effect sizes. Although statistically significant, the effect sizes for gender differences in rumination were small in magnitude. Results are discussed with respect to the RST and gender differences in depression.

Themes of relational uncertainty and interference from partners in depression

This article draws on the relational turbulence model to illuminate the dynamics of depression in romantic relationships using a thematic analysis of online discourse. Three content areas of relational uncertainty were apparent: (a) depression uncertainty (questions about physical harm, source of depression, and understanding), (b) self and partner uncertainty (questions about helplessness and identity), and (c) relationship uncertainty (questions about physical intimacy, relationship satisfaction, and the future of the relationship). Three content areas of interference from partners also emerged: (a) daily routines (disruptions to household tasks; finances, work, and school; children and parenting; and family and social life), (b) personal well-being (disruptions to health and safety as well as treatment), and (c) the relationship (disruptions to sexual activity, emotional intimacy, and openness). Relational uncertainty and interference from partners coincided in people's experiences in seven ways. The article concludes by discussing the conceptual, empirical, and pragmatic implications of the findings.

The Mediating Role of Rumination in the Relation Between Quality of Attachment Relations and Depressive Symptoms in Non-Clinical Adolescents

This study examined associations between indices of the quality of attachment relationships of adolescents with parents and peers, rumination, and symptoms of depression. More specifically, a mediation model was investigated in which rumination was hypothesized to mediate the relation between quality of attachment relations and symptoms of depression. A total of 455 high school students completed a battery of questionnaires, including quality of attachment relations, rumination, and depression. Results showed that most indices of quality of attachment relations were significantly associated with rumination and symptoms of depression. When examining the relative contribution of these variables in explaining variance in depression symptoms, trust in parents, communication with peers, and alienation from peers accounted for a significant portion of the variance in depression scores. Finally, the relation between communication with peers and depressive symptoms was fully mediated by rumination, whereas partial mediation was found for the relations between parental trust and depressive symptoms, and between alienation from peers and depressive symptoms. Implications of the findings may be that the treatment of depression in adolescence should consist of both cognitive interventions aimed at targeting ruminative thinking as well as a focus on interpersonal relationships of the adolescent with parents and peers.

An Examination of Integrated Cognitive-Interpersonal Vulnerability to Depression: The Role of Rumination, Perceived Social Support, and Interpersonal Stress Generation

This research examined an integration of cognitive and interpersonal theories of depression by investigating the prospective contribution of depressive rumination to perceptions of social support, the generation of interpersonal stress, and depressive symptoms. It was hypothesized that depressive ruminators would generate stress in their relationships, and that social support discontent would account for this association. Further, depressive rumination and dependent interpersonal stress were examined as joint and unique predictors of depressive symptoms over time. Participants included 122 undergraduate students (M age = 19.78 years, SD = 3.54) who completed assessments of depressive rumination, perceptions of social support, life stress, and depressive symptoms across three waves, each spaced 9 months apart. Results revealed that social support discontent accounted for the prospective association between depressive rumination and dependent interpersonal stress, and that both depressive rumination and dependent interpersonal stress contributed to elevations in depressive symptoms over time. These findings highlight the complex interplay between cognitive and interpersonal processes that confer vulnerability to depression, and have implications for the development of integrated depression-focused intervention endeavors.